domingo, 20 de fevereiro de 2011

How to Manage Summer Depression / Como controlar a depressão de verão

How To Manage Summer Depression

Summer DepressionSummer is supposed to be a season for fun and relaxation.  It’s that time of the year when everybody heads to the beach to get their summer tan or for a refreshing soak in the water.  It’s when you sit out on your porch or lawn drinking lemonade or iced tea during the afternoons.
You’re supposed to be relishing the joys of summer like everybody else, but you’re not.  You have summer depression.  For some, the cause is biological.  For others, the stresses of summer pile up and make them miserable.
Reasons for Summer Depression
Seasonal Affective Disorder or SAD is a form of depression which usually affects some people during the fall and winter, but affects others during the onset of summer.  Summer SAD is more common in equatorial countries than winter SAD.  Longer days and increasing heat and humidity may play a role in causing summer SAD and symptoms include loss of appetite, trouble sleeping, weight loss, and anxiety.
Disruption of routine during summer is common and can cause stress, which then leads to depression.  When school lets out for the summer, your kids’ vacation can be disruptive to your work, sleep, and eating habits.  Having a reliable routine is important to keep depression at bay, and when your routine is disrupted by having to keep your children occupied all day, everyday during their summer vacation, depression may set in.
Issues with body image arise together with the rise in temperature and as layers of clothing fall away.  People who are already self-conscious about their bodies feel more embarrassed especially because summertime gatherings require them to go to the beach wearing shorts or bathing suits.  Feelings of embarrassment may eventually lead to depression.
Financial worries contribute to summer depression, especially for working parents, when the added expenses for vacations, summer camps, or babysitters start to weigh on your mind.  On top of everything else, the financial crisis makes people feel more financially strapped, making them worry about being able to come back to their jobs if they go on vacation.
The heat is not relished by everybody.  While some may enjoy baking on a beach under the sun, others find the summer heat nothing but oppressive.  These people may resort to spending all their time indoors where they have air conditioning, sitting in front of the TV all day.  They may even avoid cooking to avoid the stifling heat in the kitchen and simply order takeout food.  Being stuck in the house may eventually cause depression.
Here are some tips to help you manage summer depression:
Address the problem right away, whether or not you know that your depression will eventually resolve itself.  Even if your bout of depression only occurs three months of the year, every year, it should not be ignored especially if it’s a problem that has a solution.  Once you recognize the onset of symptoms, get help immediately; see a doctor or any expert.  The symptoms may only last for a few months but your depression has the potential to have longer or permanent effects on your family life and your work, and can even turn into a longer-lasting period if left unchecked.
Prevention is the key. The one good thing about summer depression is you know when it’s coming.  Before spring ends and while you’re still in a lighter mood, you can start planning ahead.  Figure out what makes your life difficult during the summer and how best to deal with them.  Find ways to relieve the stresses that summer brings before they even happen.  Being in control goes a long way in preventing your depression.
Get enough sleep, even if you’re on vacation and regardless of the shorter nights.  Avoid staying up later than usual because insufficient sleep may trigger your depressive moods.
Exercise is a great activity to stave off depression.  Don’t let the stifling heat also stifle your physical activities.  You can avoid the summer heat by exercising earlier in the morning or later in the evening.  Your cool basement is a great alternative for your exercises, instead of your usual outdoor routines, if you have the equipment.  You can also opt to join a gym only during the summer if you don’t have the equipment at home.
Take it easy on your diet and exercise.  Kicking off your summer with a burst of intense dieting and exercise so you can fit into your old bathing suits will only make you more anxious.  Pressuring yourself may only trigger an attack of depression, which may then lead to failure in your anxious efforts.  Disappointment with yourself will only worsen your depressive mood.
Don’t overwhelm yourself with your usual summer obligations, like hosting an enormous family gathering during the 4th of July, especially if you don’t think you can handle it.  Traditions are important, but don’t risk pushing yourself into a bout of summer depression when you have other relatives who can do the job this year.
Figure out the cause.  Find the reason why summer triggers sadness.  Your summer is probably associated with a difficult time in the past, and you are repeating the cycle year after year.  Figure out the underlying cause so you can break the cycle.
Consider adjusting your medication.  If you are treating your depression with medicines, but they are not helping to lessen the symptoms of your summer depression, talk to your doctor about making changes.  He can make adjustments to your dosage to help keep your summer depression at bay. Better yet, use all natural remedies to beat your depression.
Carefully plan your summer vacation. Make sure that you are going on a vacation you would enjoy, and not just a vacation that fulfills an obligation.  You may only end up worrying about your finances or the responsibilities you left behind at work.  If going away will make you unhappy, then it’s not worth the trip.  There are other alternatives you can consider, like taking several long weekends off spread out over the summer, instead of going on a trip for a whole month.  You can also have a stay-in vacation instead of going away, if it’ll be more relaxing for you.  A vacation should make you feel relaxed, not depressed.
Don’t force yourself to feel something you don’t. Just because summer is supposed to be a fun time for everyone doesn’t mean that you should be having a great time like everyone else.  You will only end up making yourself miserable if you keep worrying about how you feel relative to other people.  Instead of feeling bad because other people are having fun and you’re not, spend your energies figuring out why you’re depressed in the first place so you can start conquering the problem.  Don’t let your depression conquer you.

sábado, 19 de fevereiro de 2011

Seasonal Affective Disorders - Disturbios afetivos Sazonais

Seasonal Affective Disorders

Said, M, University of Liverpool, UK.


Physicians recorded seasonal depressions as early as Aretaeus and Hippocrates. More recently, patients with regular seasonal depressions were coined as having Seasonal affective disorder (SAD). SAD is described as a subtype of affective disorder (mood disorder) with a seasonal pattern1 usually in the winter when sufferers experience clinical depression and has a greater prevalence in countries with greater northern latitude. There is some evidence to suggest the existence of a recurrent depression that occurs in summer2.               

Diagnostic Assessment

The term SAD was invented by Rosenthal et al in 1984 with the criteria shown below:

Table 1: SAD criteria of Rosenthal et al (1984)3

1) A history of major affective disorder, according to Research Diagnostic Criteria (Spitzer et al 1978)4
2) At least two consecutive previous years in which the depressions developed  during fall or winter and remitted by the following spring or summer
3) Absence of any other Axis I DSM-III psychiatric disorder (American Psychiatric Association 1980)
4) Absence of any clear-cut seasonally changing psychosocial variables that would account for the seasonal variability in mood and behaviour

Now the diagnostic term is included in the Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association. The DSM-IV is one of two standard diagnostic manuals used by psychiatrists for diagnosis, the other one being the International Classification of Diseases, currently in its 10th edition (World Health Organisation, 1992). The patient must satisfy certain criteria before a diagnosis of SAD can be made (Table 2).

Table 2: DSM-IV criteria for seasonal pattern specifier

Specify if, with seasonal pattern (can be applied to the pattern of major depressive episodes in bipolar I disorder, bipolar II disorder, or major depressive disorder, recurrent):

a. There has been a regular temporal relationship between the onset of major depressive     episodes in bipolar I or bipolar II disorder or major depressive disorder, recurrent, and a particular time of year (e.g. regular appearance of the major depressive episode in autumn or winter)

b. Full remissions (or a change from depression to mania or hypomania) also occur at a characteristic time of year (e.g. depression disappears in the spring).

c. In the last 2 years, two major depressive episodes have occurred that demonstrate the temporal season relationship defined in criteria a and b, and no non-seasonal major depressive episode has occurred during the same period.

d. Seasonal major depressive episodes (as described above) substantially outnumber the non-seasonal major depressive episodes that may have occurred over the individual’s lifetime.

Note: Do not include cases in which there is an obvious effect of season-related psychosocial stressors (e.g. regularly being unemployed each winter)

Source: American Psychiatric Association (1994).

Typically, winter SAD sufferer would be a patient who has been regularly diagnosed as suffering from major depression during the winter and remits during the summer. Around 30% of patients with SAD also experience a bipolar mood swing from depression to a feeling of elation or ‘high’, usually during spring, which if severe could be diagnosed as a hypomania.
The diagnosis must take into account any psychosocial factors that may be linked to seasonal changes in mood, e.g. unemployment during winter, whereby the effects of the season would not be the causal factor of the mood change. Evidence also shown the existence of a milder form of SAD, ‘subsyndromal SAD’ (S-SAD), which is clinically significant but not severe enough as SAD5.

Clinical features

Characteristic symptoms of SAD are those of depression, which include dysphoria, feeling low, decreased in energy and activity, increased irritability, concentration difficulties, anxiety, decreased libido and social withdrawal. Unlike classically depressed patients, most SAD patients develop ‘atypical’ symptoms of increased fatigue, increased sleep duration and increased appetite and weight. Not only do SAD patients crave carbohydrates, but also they actually report eating more carbohydrate-rich foods in the winter1.
A study point out that patients are more disturbed by the lethargy and fatigue than by the mood changes themselves, especially in the early phases of their winter depression, therefore often seeking the help of a physician rather than a psychiatrist6. Untreated, SAD episodes generally resolve by springtime, although some do not fully recover before the early summer. Many patients reported that travel to latitudes nearer the equator resulted in remission or diminishing of their symptoms3.
Winter SAD is also seen in children, who present with fatigue, irritability, difficulty getting out of bed in the morning and school problems7. The seasonal pattern of summer is opposite to that of winter SAD with reversal of their winter symptoms in summer.

Table 3 shows the comparison between SAD and non-seasonal depression.




SleepSleep more/difficulty staying awake. Occasionally, disturbed sleep/early morning wakeningDisturbed sleep/early morning wakening
Energy Fatigue often incapacitating/slump in energy in the afternoonTiredness loss of energy
EatingCraving for carbohydrates and sweet foodsLoss of appetite
ConcentrationDifficult to concentrate often with additional memory impairmentDifficult to concentrate often with additional memory impairment


Low mood during the winter, often severe. Remitting in the summer. Some experience short period of hyperactivity (hypomania) in the spring.Persistent low mood, sometimes labile


Sense of misery, loss of self-esteem; sometimes hopelessness and despair. Apathy and flat effect (mood)Sense of misery, loss of self-esteem; sometimes hopelessness and despair. Apathy and flat effect (mood)


Stress and anxiety commonStress, anxiety and aggitation


Less interest in sexLess interest in sex


Irritability, problems relating to people. Withdrawal and isolationIrritability, problems relating to people. Withdrawal and isolation
The atypical symptoms of depression are marked in bold italic and predict a good response to phototherapy in seasonal affective disorder

Table 3: Symptom comparison5


Rating scales are used to define the course and intensity of the symptoms and as a guide in an assessment interview. Two scales that are most commonly used by researchers are the Seasonal Pattern Assessment Questionnaire (SPAQ) 3, and the Hamilton Depression Scale, SAD version (SIGH-HAD). The SPAQ is a self-rating scale used to determine the seasonal variation and timing of the symptoms, but these self-report is subjective and exposed to over- and under-reporting. The Hamilton scale is used to describe symptoms and measure severity and its advantage lies in its use as an independent rating tool and as a useful measure of response to treatment.


Early SAD studies indicated that most patients met criteria for bipolar II disorder (depressive and hypomanic episodes), while only a small proportion had bipolar I disorder (depressive and full manic episodes), or unipolar depression8. More recent work, however, has found that the majority of patients to have unipolar depression, with a substantial minority of patients having bipolar II disorder and very few having bipolar I disorder9. This discrepancy could possibly be explained because of the use of different sets or criteria or due to different climatic conditions between studies.
The prevalence of SAD has been estimated to range from 0 to 9.7% depending on the population that is being sampled5. Women are approximately twice as likely to suffer from SAD than men, which is comparable to gender differences reported in non-seasonal depression although they may reflect bias in sampling10. According to a study, the mean age of onset in SAD appears to be in the thirties11.
Though the geographical distribution of SAD has not been rigorously studied there is evidence to suggest that the prevalence of SAD and S-SAD increases with an increase in northern latitude1. This led to the view that SAD is linked to the hours of daylight that people are exposed to at different latitudes, where the further north a person lives the fewer hours of sunlight exposure per day. Research in different areas of the USA found there was a correlation between latitude and prevalence of SAD (Table 4).

Table 4: The prevalence of SAD and S-SAD in a survey carried out in the USA12

Location  Latitude (north)        SAD (%) SAD + S-SAD (%)

New Hampshire

            43o            9.7           20.7
New York            40o            4.7           17.1
Maryland            39o            6.3           16.7
Florida            27o            1.4             4.0

SAD = seasonal affective disorder; S-SAD = subsyndromal SAD.
However, when compared with the results above, several studies have found lower rates of SAD in Iceland and Manitoba which are located at 63-67o north and 50o north respectively13. Even among descendants of Icelandic emigrants in Canada, the prevalence was low suggesting genetic adaptation might play an important role14. This finding seems to emphasize the importance of genetic, psychosocial, cultural and ethnic factors in the development of SAD.

Pathophysiology of SAD

Biological abnormalities have been found in winter SAD patients, including alterations in hormonal profiles, biochemical challenges, immune responses and visual evoked phenomena. Based on the research findings of phototherapy, a number of biological theories have emerged to explain SAD.

The ‘photon-counting’ hypothesis

The short days of winter deprive susceptible patients of sufficient quanta of light for some chemical process responsible for maintaining a euthymic (normal) state. So this ‘photon deficient’ depression is treated by supplementing the deficient light.
This hypothesis is based on initial report in SAD documenting that bright light acted as an antidepressant whereas dim light did not3 and further supported by data indicating that there is a dose-response relationship for light as well as an inverse relationship between duration and intensity of light required15. A limitation of this hypothesis is that it doesn’t specify what intervening processes are influenced by these varying amounts of lights, which in turn influence the outcome in SAD patients.

The ‘melatonin’ hypothesis

The hormone melatonin plays a role in the secretion and regulation of various hormones and seasonal changes in behaviour. Studies have demonstrated that melatonin is inhibited by bright light and therefore is increased in the darker winter months. So suppression of melatonin by light should induce an antidepressant effect.
The results of several studies have argued against this hypothesis. Firstly, administration of melatonin to successfully treated SAD patients did not induce them to relapse16. Secondly, SAD patients treated with atenolol (beta-adrenergic blocker) that reduces night-time melatonin levels failed to improve their condition17. These and other results suggest that the suppression of pineal melatonin secretion may account for some symptoms that resolve during light therapy, but there is no convincing evidence that it is central to the disorder.

The ‘phase shift’ hypothesis

This concept was built on the capacity of bright light in the evening to delay the nocturnal rise of melatonin and in the morning to advance the rhythm18. So the association between phase-advancing and antidepressant effects of phototherapy suggested a connection between delayed circadian rhythms and depression.
This theory postulates that time of day of phototherapy is critical to the antidepressant response. Few studies rejected this theory because it could be argued that evening light treatment should make patients worse whereas, in fact, the reverse happened19. Nevertheless, circadian rhythms may be linked since the eye may be more sensitive to light in the early morning than at other times. Unanswered questions includes are rhythms really delayed in winter SAD and whether they are the central abnormality.

The ‘amplitude’ hypothesis

This theory was developed from endogenous circadian amplitudes of variables such as temperature, melatonin and heart rate that can be markedly suppressed or enhanced depending upon the timing of light exposure. This suggests that increased circadian amplitude induced by phototherapy may result in the antidepressant effect of light20.

Neurotransmitter hypothesis

Two neurotransmitters may be playing the central roles in the pathophysiology of winter SAD: Dopamine and Serotonin.
Dopamine might play a role in SAD by modulating a ‘behavioural facilitation system’ where evidence of reduced prolactin secretion in SAD patients compared with normal volunteers in both winter and summer suggests that it might be a trait marker of the condition21. This finding might indicate a dopaminergic secretion in SAD, since low basal prolactin secretion may result from compensatory up-regulation of D2-receptors in the anterior pituitary gland associated with low functional activity of dopamine.
     Bright light allows dopamine to be produced in the retina and suppresses the production of retinal melatonin thereby improving mood by mechanisms such as resetting the circadian ocular clock or triggering dopaminergic impulses affecting central neuronal structures22.
This neurotransmitter was nominated as one whose functional deficiency might be responsible for depressive disorders in general because the therapeutic effects of some antidepressant drugs may be dependent on serotonin availability23.
Carbohydrate craving may also reflect a functional serotonin deficiency, which would be consistent with the serotonin theory of SAD, given the eminent symptom of carbohydrate cravings in winter depression3.


Winter SAD patients were shown to have normal basal plasma cortisol and Adrenocorticotrophin Hormone (ACTH) levels, but reduced ACTH responses to infusions of Corticotrophin Hormone that may occur in hypercortisolaemic patients, such as melancholic depressives24.
Other explanation include an underactive Hypothalamus-Pituitary-Adrenal axis associated with the lethargy, hypersomnia and hyperphagia compared to the agitation, insomnia and anorexia seen in melancholic depression.


There are three main courses of treatment although phototherapy has been the mainstay of treatments for winter depressions. If any single treatment proves insufficient, a combination regimen are often used, the most common being phototherapy and medication.


Phototherapy is a treatment involving daily exposure to high-intensity, broad-spectrum light. The discovery that human melatonin production can be suppressed by bright light led to the initial test of bright light in treating winter depression. The therapeutic effects of phototherapy may involve a serotonergic mechanism since rapid tryptophan (dietary amino acid precursor of serotonin) depletion appears to reverse the antidepressant effect of phototherapy25.
     The efficacy of phototherapy has been demonstrated in over 20 placebo-controlled studies around the world26,27. It is difficult to control for the placebo effect in phototherapy studies, since the patients often believe that light will be helpful and the ideal standard of a double-blind design is not possible. Many attempts have been made to control for placebo effects of light by varying intensity, colour and timing of treatment, as well as directing the light to different parts of the body. Several parameters have emerged for optimal use of phototherapy.

Parameters for phototherapy


Illuminance, measured in terms of quanta of light sensed over time by a certain surface area or Lux, was the first treatment variable studied systematically. Light boxes delivering 100-850 lux were less effective than brighter units in a series of controlled crossover studies26. Later studies indicated that an overall remission rate of 75% could be achieved using fluorescent light fixtures positioned to produce
10 000 lux28.


Some researches have found that morning is the most effective time for phototherapy, whereas others have found patients to respond well to light at other times of day29. In accordance to the phase-shift hypothesis for winter depression, morning light that causes a circadian phase advance should be more antidepressant than evening light which causes a delay. Since no studies have found that evening light to be more antidepressant than morning light, investigations have shown either no difference30 or morning light to be superior31.


Few studies indicated that the greater the daily duration, the greater the antidepressant effect, however, there is little published evidence that increased antidepressant effects may be achieved using greater than 2-hour light periods/day15.
Duration may also be inversely related to intensity in determining efficacy of treatment32


Original studies use full-spectrum fluorescent lights, which largely reproduce the distribution and range of visible and ultraviolet light. Recent studies has discussed the comparative merits of different brands of white fluorescent lamp emitting different amounts of ultraviolet radiation but to no avail33 although different wavelengths were demonstrated to have an effect where green light shown to be superior to others. Incandescent light sources may also be effective in the treatment of SAD34.

Route of delivery

Light appears to have its therapeutic effect through the eyes and not the skin in SAD patients35, even though a case report has documented the efficacy of phototherapy in a blind individual36.
When properly administered, phototherapy has no known irreversible side effects. Nevertheless, overexposure to ultraviolet light might adversely affect the eyes or the skin e.g. cortical cataract as a result of excessive long-term exposure to ultraviolet light. Some patients complain of eyestrain, mild headaches, insomnia or hypomanic irritability37.


Medications may have a role in the treatment of SAD, even though psychiatrist are aware that it is quite easy to misdiagnose SAD and treatment with conventional antidepressants often exacerbate the atypical symptoms of hypersomnia and carbohydrate craving. There have been few studies to assess how effective antidepressant drugs are in the treatment of SAD, however, the serotonin-agonist d-fenfluramine38 and the Selective Serotonin Reuptake Inhibitor (SSRI) sertraline39 has been found to be a promising treatment. SSRIs are used because of the close association between SAD symptoms and serotonergic neurotransmission. Recently another SSRI, fluoxetine usually used in the treatment of non-seasonal major depression40 also found to be effective after being compared with phototherapy41.


Cognitive behaviour therapy (CBT) helps patients regain a degree of control over their symptoms consequently managing their illness more effectively. Although it may provide some long-term benefit42, CBT alone may not be sufficient to overcome the biological effect experienced by patients in the winter.

Treatment of summer SAD

Patients with summer depression appear to respond to traditional antidepressant medications but manipulations of the environmental stresses in summer, e.g. heat and humidity, have not yet been demonstrated to be as effective as phototherapy for winter SAD43. It would be more difficult technically to perform controlled studies on the effects of environmental temperature as compared to light.

Limitations and future research

Despite the development of several theories on the aetiology of SAD and its treatment, all these have theories have limitations. The biological causes of SAD might benefit from proper family studies exploring possible genetic or familial environmental factors that might contribute the illness and their impact on society. The controversy of phototherapy still stands but as new technologies allow the delivery of light through devices other than light boxes, more sophisticated placebo controls will probably confirm the clinical and research data that already suggests that phototherapy works by more than simply a placebo effect. Formal studies of its safety, especially with long term use, may also be desirable. Summer SAD has been defined but has yet to be fully explored and whether this is a distinct diagnostic syndrome remains debatable. Lastly, more clinical trials on the potential roles of diet and cognitive therapy and the efficacy of various antidepressants in SAD have yet to be undertaken.


SAD is a recurrent depressive disorder occurring at particular times of the year with some atypical symptoms which include hypersomnia, hyperphagia, carbohydrate cravings and increased weight. The specific aetiology of SAD remains unclear although the neurotransmitter serotonin may play a significant part. Both phototherapy and some SSRIs (fluoxetine) produced a good antidepressant effect and were well tolerated, either alone or in combination; however, a larger sample is required to confirm an apparently better response to phototherapy.


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« Psychiatry

Version 1.0 Published January 2001

Depressão sazonal sob o olhar do sol - Sad at the sight of the sun Kate Corr

Summer sad, or Reverse seasonal affective disorder

Summer Sad, R.s.a.d. Reverse Seasonal Affective Disorder

Read more:
R.S.A.D reverse seasonal disorder, is a type of depression that badly affects people in the summer. It is not know exactly why this depression happens in relation to the brain, whether it is because they can’t cope with to much heat or to much sunlight it is unclear.
The origins of R.S.A.D are unknown and many people who have summer depression just think it’s down to events rather than being part of a pattern, which could take a few years to establish. If you think you may be suffering from R.S.A.D then start making a diary of your mood and the exact weather conditions. Or think back over the last few summers, can you pin point your mood. Add the way you felt with an episode of your life? Something that should have made you very happy but you still felt incredibly sad?
The symptoms for R.S.A.D are very different to S.A.D
1.  You will feel very depressed
2.  Agitation
3.  Anxiety
4.  Insomnia
5.  Poor appetite
6.  Loss of weight
7.  Increase in sexual activity but never being satisfied
8.  In extreme cases fantasies of suicide
9.  Lack of concentration
The first reported case of S.A.D was in 1984 by Dr. Wehr and Dr Rosenthal. Tyhier findings also brought up people who said they felt depressed in the summer.
The two Dr’s manipulated peoples body temperatures. People with depression tend to show higher body temperature at night and people on antidepressants show a lower body and brain temperature.
After the doctors had heated the people up, they then cooled them down with reverse thermal blankets. The people went out side feeling better but on entering the heat and light of a summer’s day all their symptoms of depression came back.
Many patients have just learnt how to deal with Summer S.A.D. but again as with the winter sadness, it seems more women than men suffer with it.
Although you are limited to treatments apart from antidepressants / mood stabilisers, there are things you can try to see if they bring you some relief.
1.  Keep out of the heat in an air-conditioned room
2.  Go outside in the evening or early morning
3.  Keep an ice pack or cold clothe around the back of your neck
4.  Sunglasses
5.  Sleep with ice-cold water bottles.
6.  Frequent cold showers
There have been some links between summer sad and bipolar, so any signs of depression should be checked by your own Doctor.
Author lillyrose 6/11/09

sexta-feira, 18 de fevereiro de 2011

Textos sobre depressão sazonal de verão...meu resumo de leituras

Elaborei este resumo das leituras que tenho feito porque nem todo mundo lê inglês e a maioria dos textos e pesquisas estão nessa língua, mas mantenho as indicações dos textos originais para facilitar a pesquisa de quem quer saber mais sobre o assunto.
Críticas, correções e outros comentários podem ser postados no final como comentário. Obrigada.
Sônia Maria Ramires de Almeida
Não fique aí deprimida. Saia de casa, é verão, o sol brilha!


Embora a maioria das pessoas pense em tristeza ou na dor de alguma perda diante da palavra depressão, para os médicos, psiquiatras e psicólogos, e mesmo para os meios de comunicação não se encontrou melhor termo para denominar essa doença. Isso causa bastante confusão para o paciente, seus amigos e familiares. E a coisa fica ainda mais complicada quando a gente, tentando entender, se depara com várias descrições e diagnósticos desse tipo de distúrbio.

Felizmente para os pacientes, vai ficando cada vez mais conhecido o fato de que depressão é uma doença clínica, definida e descrita como transtorno de humor ou transtorno afetivo . Cabe ao médico avaliar a existência de outras doenças que possam provocar sintomas semelhantes aos da depressão para chegar a um diagnóstico mais seguro. Até o momento não existem, ou pelo menos não há consenso sobre, exames de laboratório ou físicos que possam indicar o distúrbio. A avaliação é principalmente clínica.

Neste texto, o objetivo é fazer um estudo de uma forma específica de depressão, a chamada depressão sazonal ou distúrbio afetivo sazonal (DAS). De fato a terminologia mais encontrada atualmente é em inglês: Seasonal Affective Disorder (SAD), porque o maior número de publicações e pesquisas dessa área foi feito nos Estados Unidos. Summer SAD, summer depression e winter blues são denominações correntes para os distúrbios afetivos sazonais.
Como SAD é uma sigla que coincide com a palavra sad (tristeza) pode-se encontrar alguma tradução equivocada. O distúrbio pode ocorrer nos meses de outono/inverno ou na primavera/verão.

Explico rapidamente meu interesse no tema: há anos sou acompanhada pelo mesmo psiquiatra, com episódios recorrentes de depressão. Ao tentar encontrar uma conexão entre ela e a enxaqueca , a fibromialgia e o hipotireoidismo surgiu uma constante curiosa: tudo parecia piorar no verão. Letargia, dores no corpo, dificuldade de concentração, cansaço permanente, enxaqueca, transpiração excessiva, ataques de fome insaciável que culminavam numa crise de depressão praticamente incapacitante. Em contraste com essa intolerância ao verão, era notável a energia e a alegria de viver que eu experimentava durante o inverno em cidades mais ao sul tais como Buenos Aires e Montevidéu.

Ao ter a liberdade de discutir essas sensações com meu psiquiatra fui percebendo que nessa depressão havia um componente físico importante, que não me faltava o desejo de viver e fazer as coisas que me davam prazer: eu não fazia essas coisas porque meu corpo não obedecia aos apelos de minha vontade, era como uma marionete cujos fios estivessem soltos...Ao contrário, sob baixas temperaturas, uma outra pessoa despertava, feliz da vida, pronta para estudar, ouvir música, fazer longos passeios pelos parques...

Mais segura de que isso não era "loucura" ou excentricidade comecei a pesquisar e buscar informações sobre ondas de calor, clima e saúde, etc. Por sorte tenho formação em Ciências Sociais e pude evitar o naufrágio ao navegar na Internet, selecionando textos pertinentes de especialistas e pesquisadores.

Uma das primeiras publicações onde encontrei o que buscava foi um livreto chamado "Depressão Comprometa-se com seu tratamento" (1) onde havia uma lista dos sintomas e algumas denominações usadas para caracterizar os sintomas depressivos entre as quais:
"Depressão Sazonal que pode se apresentar com qualquer tipo de sintoma, mas que é marcada pelo aparecimento numa época específica do ano, outono-inverno (sazonal de inverno), primavera-
verão (sazonal de verão). "

Tendo um nome e uma definição parti para a busca de mais informação e tive uma enorme surpresa: "Depressão sazonal pode acompanhar o sol do verão"(2) era o título de uma nota jornalística. Nessa matéria li com alívio o relato de Violet Adair, paciente afetada pela depressão sazonal de verão que adaptou sua casa e seu modo de vida para sobreviver durante esse período, limitando o número de janelas, pintando as paredes de cores frias como azul , distribuindo ventiladores e evitando ao máximo os ambientes exteriores. Outros pacientes permanecem o maior tempo possível em ambientes refrigerados, tomam repetidos banhos frios e para muitos a principal arma é farmacológica. Outra paciente citada chega a dizer que se sente atacada pelo sol, desesperada para escapar.
O mais interessante nessa matéria foi saber que os doutores Norman E. Rosenthal e T.Wehr, que identificaram em1984 a depressão sazonal de inverno foram procurados por pacientes que diziam apresentar os mesmos sintomas descritos mas durante o verão. A partir desses fatos os pesquisadores se dedicaram a analisar esse tipo de depressão sazonal. É notável que praticamente todos os que enfocam a depressão sazonal de verão levem em conta os estudos de Rosenthal e Wehr.

Outro texto "Dog Days of Summer" (Dias caniculares de verão) (3) cita "Jackie" , paciente do Dr. Norman Rosenthal que sofre de depressão sazonal de verão. Por esse motivo passa todo o verão tomando antidepressivos. Antes do diagnóstico e tratamento suas crises eram tão profundas que chegava a pensar em suicídio.

Os pesquisadores enfatizam que os casos conhecidos de depressão sazonal de verão são menos numerosos que a variante de inverno e tendem a surgir em zonas de clima mais quente. As causas desses distúrbios sazonais permanecem ainda desconhecidas mas parecem apontar para a falta de luminosidade nos casos de inverno e para o calor e umidade nos casos de verão. Há também a hipótese baseada na região do hipotálamo, que controla os hormônios corporais e tem relação com os sensores de temperatura.

Para os casos de depressão de inverno existe o tratamento com lâmpadas que substituiriam a luz solar; para os casos ocorridos no verão é recomendado o uso de antidepressivos e ambientes refrigerados ou até mesmo temporadas em lugares de clima mais frio.

No Yahoo! Health Groups o grupo chamado "summerdepression" tem nome e descrição bem objetivos. Traduzindo livremente temos:
"...Com a chegada do verão como é afetado seu estado de ânimo? Você fica inquieto? Você se afasta do convívio social? Não consegue ter um sono reparador? Fica esperando os efeitos calmantes do outono?
Você não está sozinho. A variante de verão do distúrbio afetivo sazonal - DAS - pode afetar qualquer pessoa, causando profundas mudanças de humor e comportamento. Enquanto a depressão sazonal de inverno é bastante conhecida, pouco se sabe sobre a igualmente incapacitante depressão sazonal de verão.
Este grupo é para os que sofrem da versão dita "mais rara" desse distúrbio, a depressão sazonal de verão, "os esquecidos". Qualquer pessoa que sofra desse mal, assim como as pessoas que se relacionam com seu tratamento serão bem vindas..."
É altamente consolador para quem sofre de um mal pouco conhecido ler ou ouvir outras pessoas com problemas semelhantes. O contato, além de animicamente positivo faz com que sejam conhecidos tratamentos, medicamentos e pesquisas sobre a enfermidade.
Selecionei algumas frases dos participantes do grupo citado para mostrar o alívio que sentiram ao saber que não são os únicos no mundo: "As pessoas pensam que estou louca..." "Deixo o ar condicionado ligado o verão todo..." "Eu não sabia que outras pessoas sentiam a mesma coisa..." "No verão me sinto mal o tempo todo..." "O diagnóstico é obscuro, poucos médicos conhecem e pouca gente ouviu falar..." "Feliz por saber que não sou a única pessoa..." "Chego à beira do suicídio..." "Eu me sinto voltar à vida com a aproximação do outono..." ...Eu amo o inverno, dá mais energia e a cada ano eu temo o verão..." "Estou despertando, amo o inverno..." "Boas novas para todos: o outono está chegando, o horrível verão acabou..." "Moral da história: vamos todos para a Islândia..."

Definindo o distúrbio

Uma descrição do distúrbio afetivo sazonal (DAS) ou seasonal affective disorder (SAD) foi publicada em janeiro de 1984(4).
Nesse artigo os autores citam as conclusões de outros investigadores que apontavam para uma marcada associação entre as estações do ano e a incidência de depressão, mania, suicídios e tentativas de suicídio mas enfatizam que pouco se havia publicado a respeito da repetição de episódios ano após ano, ou seja a identificação da sazonalidade como componente importante a ser avaliado.
O estudo descreve 29 pacientes que sofriam depressões no outono e no inverno e que melhoravam na primavera e verão. Relata ainda as primeiras tentativas de modificar a depressão alterando as condições de luz do ambiente.
Como os primeiros estudos de depressão sazonal foram feitos com pacientes que sofriam o distúrbio no inverno, para alguns autores ficou marcada a falsa impressão de que esse mal dizia respeito somente ao hemisfério norte, onde o inverno é mais rigoroso e que o verão produzia efeitos benéficos sobre os pacientes deprimidos.
Felizmente a equipe que identificou o distúrbio afetivo sazonal não se deteve nos primeiros achados e aos poucos surgiram pacientes que se identificavam com o diagnóstico mas enfatizavam que sua depressão surgia nos meses de primavera ou verão, melhorando no inverno.

Num relatório de dezembro de 1987, os autores Wehr, Sack e Rosenthal descrevem doze pacientes que regularmente ficam deprimidos no verão(5). O padrão encontrado é oposto ao anteriormente descrito em que os pacientes ficam deprimidos no inverno e reagem bem ao tratamento com luz. Aparece aqui a suposição de que a temperatura pode ter influência sobre a depressão de verão. Psiquiatras, trabalhando com questionários aplicados a pacientes, coletaram informações sobre sintomas, histórico familiar e de tratamentos médicos.
Entre os sintomas mais comuns encontramos: perda de energia, retraimento social, falta de vontade, baixa auto-estima, diminuição da comunicação, perda de interesse, excesso de sono, tristeza, desamparo, sentimento de culpa, idéias suicidas e diminuição da libido. Alguns pacientes disseram que seu estado clínico parecia ser influenciado por fatores do ambiente como temperatura, umidade, latitude e luz. Alguns também disseram que os sintomas pareciam diminuir ou aumentar conforme a região em que estivessem.
A ocorrência regular da depressão no fim da primavera e durante o verão entre os pacientes estudados, coincide com a incidência epidemiológica de depressão e suicídio verificada em outras pesquisas.

A possível influência da temperatura ambiente sobre o estado clínico dos pacientes surge como uma hipótese a ser testada em estudos controlados levando em consideração também outras variáveis ambientais e psicológicas. Uma vez estabelecida essa possibilidade pode-se tomar medidas preventivas tais como manipulação de temperatura, iluminação especial ao lado de estudos mais aprofundados para aplicar ao tratamento dos distúrbios afetivos sazonais.Não é de hoje...

A influência das alterações climáticas e sazonais sobre o comportamento e a fisiologia animal e humana é conhecida desde a Antiguidade. Ao lado de idéias místicas e tradições folclóricas compartilhadas por vários povos, encontramos na História da Medicina diversos estudos e tentativas de explicação para essa influência. Com a evolução da ciência de maneira geral, a possibilidade de medições meteorológicas, a realização de pesquisas controladas e a convergência de vários ramos do conhecimento abrem-se novas perspectivas para investigação e busca de solução de problemas nessa área.

Para nossos objetivos estivemos buscando os estudos mais atuais que fazem uso de modernas técnicas de pesquisa, levantando hipóteses, tentando estabelecer critérios que possam resultar em melhor conhecimento dos distúrbios e um tratamento mais eficaz.Ainda há muito a descobrir
M. Said, da Universidade de Liverpool, Reino Unido apresenta um bom resumo do que até o presente se estudou e descobriu a respeito dos distúrbios afetivos sazonais(6).
Discute os critérios usados pelo Dr. Norman Rosenthal e equipe em 1984 e informa que o termo SAD e seu diagnóstico faz parte do Manual Estatístico e Diagnóstico de Distúrbios Mentais da Associação Psiquiátrica Americana. Há critérios bem especificados para estabelecer o diagnóstico e a sazonalidade do distúrbio.

No que diz respeito às causas, há várias hipóteses a respeito da susceptibilidade de alguns pacientes a mudanças climáticas e ambientais entre as quais: a menor duração do dia durante o inverno, alterações na produção de melatonina, alteração dos ritmos circadianos, hipótese sobre o papel dos hormônios e dos neuro-transmissores tais como dopamina e serotonina, igualmente se estuda o eixo hipotálamo-pituitária-adrenérgico. O conhecimento acumulado pode levar a tratamentos mais eficientes e bem estar aos acometidos por esse tipo de distúrbio.

Embora a bibliografia sobre o tema seja na maioria dos casos referida a pacientes com problemas durante o inverno do hemisfério norte, na Europa e Estados Unidos, há trabalhos publicados referentes a outras regiões e latitudes.

Uma equipe, trabalhando com dados coletados entre trabalhadores de Nagoya, Japão, chegou à conclusão de que alterações sazonais no comportamento e humor também ocorrem no Japão mas seu perfil é diferente do encontrado nos Estados Unidos e Europa(7). O número de pessoas que afirmaram sentir-se pior no verão ultrapassou os que relataram sentir-se pior no inverno.

Outro grupo procurou avaliar a freqüência das variações sazonais sobre o comportamento e humor de estudantes de medicina em Jining, China(8). Seus dados mostraram que os problemas vinculados ao verão eram mais comuns que os relacionados ao inverno revelando um contraste com a maioria dos estudos ocidentais e maior coerência com outros estudos publicados, feitos na Ásia. (n
O mesmo grupo, colhendo dados entre outros estudantes da mesma cidade chegou a resultados semelhantes: há predominância de problemas durante o verão em comparação com os problemas durante o inverno (9).

O mais importante para o paciente que apresenta este tipo de depressão é saber que não está inventando coisas ou fingindo sintomas. Não se trata de gostar ou não de uma determinada estação do ano. Trata-se de uma reação do organismo a determinadas condições meteorológicas e ambientais.

 Na Europa é comum encontrar nos meios de comunicação os alertas meteorológicos, a descrição dos cuidados que devem ser tomados durante as chamadas ondas de calor, as recomendações para manter o conforto térmico nos ambientes de trabalho, etc.

No Brasil essa questão parece ser minimizada uma vez que se cristalizou uma ideologia do clima tropical como sinônimo de alegria, descontração, sol e praia. Somente quando algumas enfermidades surgem mais ameaçadoras é que se decide fazer campanhas contra os ratos, mosquitos e outros possíveis agentes transmissores que proliferam no calor.
Pensando nos rigores do calor e umidade em certas áreas do Brasil eu me pergunto: quantas pessoas vítimas de crises às vezes incapacitantes sofrem por serem julgadas preguiçosas e indolentes, repetindo a velha história do Jeca Tatu, quando na verdade estariam sofrendo distúrbios sazonais? Como as doenças desse tipo não são detectadas por exames de laboratório e necessitam observação clínica e acompanhamento ao longo do tempo fica parecendo uma preocupação supérflua diante de males mais prementes.

Penso ser uma questão de saúde pública o conhecimento da interação entre clima, meio ambiente e o bem estar físico e psíquico dos cidadãos. Construções planejadas para o tipo de clima em que serão implantadas, controle da poluição ambiental, adequação das atividades, planejamento urbanístico não devem ser vistos como Utopias mas sim como condições necessárias para o pleno desenvolvimento dos cidadãos.
Questionário para saber se há diferenças observadas com a mudança de estação:
Traduzido e adaptado de questionário criado por N.E.Rosenthal e outros (domínio público)
The Seasonal Health Questionnaire
Fato observado Tipo de alteração e número de pontos atribuídos:
Nenhuma(0) Leve (1) Moderada (2) Marcante (3) Muito Marcante (4)
Duração do sono
Atividade social
Bem estar
Nível de energia
De 4 a 7 pontos - sem significação.
De 8 a 11 pontos - Distúrbio afetivo sazonal (sub-síndrome)
Mais de 11 pontos - Distúrbio afetivo sazonal
Por ser um teste auto-aplicado seu significado deve ser apresentado ao médico para que ele possa
avaliar e fazer um diagnóstico completo
Para saber mais:

(infelizmente alguns textos encontrados na internet não estão mais disponíveis)
1 - Depressão - Comprometa-se com seu tratamento
A.Miranda-Schippa e I. Reis de Oliveira
Laboratórios Wyeth-Whitehall Ltda
2 - Seasonal Depression can accompany Summer sun
Sara Ivry
NY Times, August 13, 2002
3 - Dog Days of Summer
Claudine Chamberlain
4 - Seasonal Affective Disorder
N.E.Rosenthal et alii
Arch.Gen.Psychiatry - vol.41, jan. 1984
5 - Seasonal Affective Disorder With Summer Depression and Winter Hypomania
Thomas A. Wehr et alii
American Journal of Psychiatry 144:12, December 1987
6 - Seasonal Affective Disorders
Said M.
University of Liverpool UK
7 - The prevalence of seasonal difficulties among Japanese civil servantes
Ozaki N. et alii
American Journal of Psychiatry 152:1225-1227, 1995
8 - Seasonal variations in mood and behavior among Chinese medical students
American Journal of Psychiatry 157(1):133-135, January 2000
9 - "summer and Winter patterns of seasonality in Chinese college students: a replication
Compr. Psychiatry 41(1):57-62 Jan-Feb 2000
De 8 a 11 pontos - Distúrbio afetivo sazonal (sub síndrome)
Mais de 11 pontos - Distúrbio afetivo sazonal
Sendo um teste auto aplicado seu significado deve ser apresentado ao médico para que ele possa avaliar e fazer um diagnóstico completo.Para saber mais:



quinta-feira, 17 de fevereiro de 2011


Understanding Summer Depression

Symptoms, Causes &Treatment of Reverse Seasonal Affective Disorder

Mar 17, 2008
Sufferers Feel Attacked by the Sun, Bram Janssens
This article offers an overview of reverse seasonal affective disorder, the rare summer form of SAD that can signifcantly impact on the lives of sufferers.

Summer depression is a rare variant of seasonal affective disorder (SAD) with a spring onset, affecting sufferers through the lighter, hotter months. It manifests with some symptoms that are the reverse of those suffered in the winter form. It is sometimes referred to as “reverse seasonal affective disorder” or “summer SAD”.
The most common type of SAD is often described as “winter depression”, and includes symptoms such as low mood, oversleeping and increased appetite. These symptoms occur in the autumn and winter months.

Symptoms of Summer Depression

The DSM-IV notes SADs as “specifiers”, seasonal patterns that can occur within major depressive or bipolar disorders. Sufferers of summer SAD may experience some or all of the following symptoms during the spring and summer months:
  • Depression, feelings of hopelessness
  • Loss of interest and/or enjoyment in activities
  • Anxiety
  • Insomnia
  • Feelings of irritability
  • Feelings of agitation
  • Poor appetite
  • Weight loss
  • Increased sex drive
  • Suicidal thoughts and feelings
These symptoms subside in the fall, reappearing the following spring.

Causes of Summer Depression

Like other types of depression, determining a cause is not straightforward, and clearly more research is needed to better understand this disorder. Winter depression is strongly linked to a lack of sunlight, so it is logical to assume that summer depression may be linked to too much sunlight. Although this may be an important part of the picture, the little research that has been carried out suggests that temperature increases play a much more significant role.

Prevalence of Summer Depression
Summer SAD is thought to affect less than 1% of the US population. These sufferers appear to live in hotter regions and, as is the case with other depressive disorders, they are more likely to be female. It is hard to determine the true number of sufferers and significance of gender variation, as people may feel uncomfortable coming forward. Some may manage their symptoms themselves, without seeking advice.

Treatment for Summer Depression

The symptoms of summer depression may have a significantly negative impact on sufferers’ lives, making it difficult for them to function. As with the causes, there is very little evidence on how best to treat to treat summer SAD, though a few possible treatments have been highlighted by researchers.
Sufferers often attribute their symptoms to the summer heat, reporting relief from symptoms by staying indoors and keeping cool. Some find relief in air-conditioned environments and/or taking regular cold showers.
So far, summer SAD has been shown to respond to antidepressant medication, which helps to elevate mood by altering levels of certain neurotransmitters, such as serotonin. These chemicals are strongly linked to mood and have shown to be effective in treating other types of depression, including winter SAD. Since it may take several weeks for antidepressants to kick in, a doctor may suggest beginning a course of medication in the late winter, before the onset of symptoms.
In non-seasonal depression and winter SAD, sticking to a healthy diet, doing regular exercise and accessing talking treatments have all been shown to be helpful, though it is unclear if these will help summer SAD sufferers.
For some self-help strategies, including information on sleep and diet, read Self-help for Summer Depression. Anyone suffering symptoms of summer SAD should seek advice from a qualified health professional.


Seasonal Affective Disorder: American Family Physician, accessed 17th March 2008, no author specified
Seasonal affective disorder with summer depression and winter hypomania: American Journal of Psychiatry, accessed 17th March 2008, authors - Wehr, TA; Sack, DA; Rosenthal, NE

The copyright of the article Understanding Summer Depression in Depression is owned by Barbara Melville. Permission to republish Understanding Summer Depression in print or online must be granted by the author in writing.

Here come the summertime blues
De: "John R Bolam" <Data: Tue, 02 May 2006 10:25:06 -0000
Assunto: [summerdepression] Here Come The Smmertime Blues

I found this bit of imformation on the website:

I enclose the full text here, as we all know webpages do not stay
online for ever.


For many people, the arrival of sunny days and blue skies is a cause
of deep gloom

While there are many of us that welcome summer, and it is not far
away, there are others that hate the first glimpses of sunshine and
blue skies. It has been discovered by the psychologists that it is
not only the dark winter months that you can give rise to seasonal
affective disorder (SAD), with its symptoms of depression and
fatigue. On the other hand for the people that have summer (or
reverse) SAD, the sun coming out is not a cause to be happy.

By experts at America 's National Institute of Mental Health (NIMH)
there are looking into what actually starts the summertime blues. It
is less common than the winter form of SAD, but there are up to one
in three of the population that are said to have this, the summer
form is none the less affects roughly 600,000 people in the UK and
is no less incapacitating. There are some sufferers that go to great
measures to stay out of the sun's rays and warm weather.

Due to the low profile of this condition could mean that they be
unaware of the reason for their dips in mood when the clocks go

"We have had calls from quite a few people who have symptoms of
summer SAD but have never heard of it," says Amelia Mustapha, a
spokeswoman for the Depression Alliance. "It is an area that is
currently being looked at more closely, but because so little is
known about it, people are often misdiagnosed or not taken seriously
by their doctors when they complain of summer depression."

The researchers do know that when the weather is better, the worse
summer SAD is. This could be a reason why they say, why the
Australian Gold Coast and California , both of which have a
desirable amount of sunshine, and it is the home to some of the most
depressed people in the world.


Professor Norman Rosenthal, a psychiatrist and SAD expert at
Georgetown University says, that nobody knows what causes it. "It
could be the increased light or the rising temperatures," he says.
There are other researchers that think that there could be a genetic
connection to SAD, as there are more than two thirds of patients
that were studied have a relative with a form of mental illness.

Some more of them think that the solution could be in the brain's
hypothalamus, the control centre for hormones. However, it's linked
to temperature sensors, and certain mental coping mechanisms could
be affected when the temperatures increase.

It has been shown by Professor Wehr in trials that people with the
condition are more likely to experience a considerable rise in body
temperature at night in contrast to non-sufferers. "When depressed
patients were wrapped in cooling blankets at night, their
temperatures dropped and their symptoms disappeared," Prof Wehr
says. "As soon as they went outside into the summer heat, their
depression returned."


It is believed that Winter SAD is linked o the lack of sunlight that
increases the production of the sleep-related hormone melatonin,
which has the results in overpowering feelings of tiredness and
depression. Frequently they are accompanied with a desire for
carbohydrate foods and weight gain.

For summer SAD the symptoms are different. They tend to begin in
early spring and carry on until the clocks are put back. The
sufferers tend to complain of feeling nervous and restless along
with having insomnia. They often feel uncomfortably warm at night.

In the severe case of both forms, the sufferers can get clinically
depressed. Double as many women suffer both forms of SAD and it
happens mostly during the reproductive years.


There are simple measures that you can take, to tackle summer
depression according to Professor Rosenthal these include using
blackout curtains or blinds and to open windows at night when the
weather is warmer.

It could even help you to avoid the bright light by wearing
sunglasses. Also if you take cooling blankets or frozen hot water
bottles to bed and regular cool showers.

Prof Rosenthal also advises getting a thyroid check, as "there is
some evidence that people with summer SAD have low thyroid

Amelia Mustapha says that exercise and a healthy diet are important
mood boosters. "If symptoms persist, it is important to see your GP
about your summer depression so that medication -usually anti-
depressants - can be prescribed."

There ain' t cure for the summertime blues - Clare Allan - The Guardian

There ain't no cure for the summertime blues
Clare Allan
Wednesday June 06 2007
The Guardian

This is the time of year when people start raising their expectations. Weekend
picnics are planned in the park, and tables appear outside cafes. Bare legs,
flip-flops, strappy tops, music blaring from open windows, "Hey, you! Smile!
It's summer!" This is the time of year I brace myself.

In the UK, of course, experience has taught us not to expect too much. Just as
we weren't supposed to get the Olympics or a decent millennium firework display,
we fully expect our summers to be rained off. When they're not - and, let's face
it, they're increasingly not - the pressure to "make the most of it" becomes
almost a moral imperative. "Sitting inside on a day like today? You must be mad!
What a waste!"

The temperature charts in newspapers receive the sort of scrutiny normally
employed by investors scouring the FTSE 100. "We were hotter than Malaga
yesterday! That's where the neighbours have gone. Imagine! Wouldn't you be
gutted!" You present an alternative view at your peril; dissent is a threat to
us all. Like favoured children, we live in fear that, should we not show
ourselves suitably grateful, the sun will desert us and head off to Spain or the
south of France or Sicily, or some place where they'll appreciate it properly.

Oh, I don't doubt summer is all very well in its way. I suppose it must save on
the heating bills, you get a good dose of vitamin D, and the winter depressives
sigh with relief - again and again and again and again, loudly.

"But what about summer depressives?" you scream - or I do. "What about me?" I'll
admit that until five minutes ago I didn't know I existed. Such is the
self-absorbed nature of depression that it never once occurred to me there might
be another being on the planet who struggles through summer as I do. But,
according to an article in the New York Times, summer depression is, in America
at least, a recognised disorder. Of course, this doesn't actually mean much more
than that somebody somewhere is marketing something that claims to cure you of
it, but none the less I find the knowledge oddly reassuring.

Seasonal affective disorder (SAD) is well recognised, at least in terms of
winter depression. Lamps are widely available, and "winter blues", though
varying greatly in degree, are an accepted fact of life. But one of the worst
things with summer depression is that sense of being out of sync. Not liking
summer is like crying at a party - it simply isn't done. Depression is almost a
criminal offence, and I don't doubt it will soon become one, with police
afforded special powers to stop you and check if you're looking happy enough.

According to the New York Times, around 5% of adult Americans suffer from winter
SAD and less than 1% its summer variant. Of course, much of the US is hotter
than here - if that makes any difference, which it seems to - but even if levels
in the UK are just a quarter of those across the Atlantic, that still leaves
12,500 people enduring their various levels of summer hell. So where are they
all? If they're like me, they're hiding indoors.
It is generally thought that winter depression is linked to levels of melatonin
and brought on by absence of light - hence the sun lamps. But summer depression
is less well understood. The question of whether it's too much heat or too much
light has yet to be resolved. A study conducted by Thomas Wehr, of the National
Institute for Mental Health in the US, involved cooling patients down by using a
sort of reverse thermal blanket. When they went back outside into the sun, the
symptoms of their depression returned.

I don't have much to contribute to the heat versus light debate. For me, it's
more a question of surviving the symptoms. Come spring, I'm already starting to
panic, and I never truly breathe easy until the autumn. It's a feeling of being
at once trapped and exposed, of having nowhere to hide.

My tips for making it through the summer are a sort of tragicomic reversal of
the strategies others employ in wintertime: take a break to somewhere cool.
Buenos Aires is good right now, only 4C, but if you can't manage that, at least
take a look through those temperature charts and dream

&#183; Clare Allan is a writer and novelist